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目的探讨早期非小细胞肺癌(NSCLC)经18F-脱氧葡萄糖正电子发射断层-X线计算机体层成像(18F-FDGPET-CT)定位后进行三维适形放射治疗的疗效、不良反应及失败原因。方法68例早期NSCLC(临床Ⅰa～Ⅱb期),患者用信封法随机分为PET-CT定位三维适形放疗组(PET-CT组)和普通CT定位三维适形放疗组(普通CT组)。PET-CT组经PET-CT扫描,将PET图像和CT图像融合后进行靶区和重要脏器勾画,制定治疗计划后进行常规分割三维适形放疗40Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量65Gy～75Gy;普通CT组采用普通CT定位设野,三维适形放疗至相同剂量。结果 PET-CT组的平均大体肿瘤靶体积(GTV)、计划治疗靶体积(PTV)均比普通CT组小(均P<0.05);PET-CT组患者左肺V20、右肺V20、心脏V40、食管V40、脊髓V40分别比普通CT组小(均P<0.05);近期疗效中,两组的总有效率差异无统计学意义(P>0.05);PET-CT组患者1、2级肺和气管的放射损伤发生率低于普通CT组(P<0.05);PET-CT组患者1、2、3、4、5年局部控制率和生存率均高于普通CT组(均P<0.01);治疗失败的主要原因为远处转移。结论 PET-CT定位可以优化早期NSCLC的放疗设野计划,提高局部控制率和远期生存率,远处转移为主要失败原因。
Objective To investigate the curative effect, adverse reactions and causes of failure of three-dimensional conformal radiotherapy after early-stage non-small cell lung cancer (NSCLC) localization by 18F-FDG PET-18F-FDG PET-CT. Methods Sixty-eight patients with early stage NSCLC (stage Ⅰa-Ⅱb) were enrolled in this study. The patients were randomly divided into PET-CT three-dimensional conformal radiotherapy group (PET-CT group) and ordinary CT three-dimensional conformal radiotherapy group (CT group). PET-CT group by PET-CT scan, the PET image and CT image fusion target area and important organs outlined, the preparation of the treatment plan after the conventional three-dimensional conformal radiotherapy 40Gy, and then appropriate reduction for the residual tumor lesions radiotherapy To a total dose of 65Gy ~ 75Gy; ordinary CT group using ordinary CT positioning field, three-dimensional conformal radiotherapy to the same dose. Results The average gross tumor target volume (GTV) and planned target volume (PTV) of PET-CT group were smaller than those of common CT group (all P <0.05). The left V20, right V20 and V40 , Esophageal V40 and spinal cord V40 were lower than those in the normal CT group (all P <0.05). There was no significant difference in the total effective rate between the two groups (P> 0.05) (P <0.05). The local control rate and survival rate at 1, 2, 3, 4 and 5 years in PET-CT group were significantly higher than those in CT group (all P <0.01) ); The main reason for treatment failure is distant metastasis. Conclusion PET-CT localization can optimize the radiotherapy field planning of early stage NSCLC, improve the local control rate and long-term survival rate, and distant metastasis as the main cause of failure.